Tosha Ann Leggett

Detail-oriented and highly analytical Licensed Practical Nurse with over 10 years of experience in HEDIS abstraction, utilization, and clinical review. Specializes in assessing medical necessity for patient treatments. Expertise in analyzing complex clinical data ensures compliance with insurance guidelines while optimizing healthcare costs without compromising patient care standards. Proven track record of effective collaboration with providers to implement evidence-based care plans, enhancing resource allocation in dynamic clinical environments. Recognized for critical thinking, attention to detail, and adaptability to evolving healthcare needs, consistently delivering high-quality outcomes.

• Successfully implemented new process, increasing staff compliance with documentation standards, and leading meeting to improve patient care.
• Ensured timely completion and submission of all required assessments, which helped maintain federal and state funding.
• Increased resident satisfaction by ensuring that patient needs were met and care plans were followed.
• Maximized facility reimbursement by capturing accurate care levels and ensuring correct medical coding.
• Securing appropriate Medicare and Medicaid reimbursement for the facility by accurately coding MDS assessments to reflect the true complexity and care needs of each resident (Patient-Driven Payment Model - PDPM).
• Leading and coordinating the interdisciplinary team (nursing, therapy, social work, dietary, etc.) to ensure a holistic and collaborative approach to resident assessment and care planning.

• License Practical Nurse April 2022 to September 2026
• BLS Certification March 2024 to March 2026
• ACLS Certification
• Certified Safety Professional
• Compact State Nurse License
• First Aid Certification
• Certified Home Health Aide
• AHA Certification
• Certified Surgical Technologist
• Certified Medical Assistant
• CCMA Certification
• AED Certification

• American Nurse Association
• AST